Pelvic Health 101

We get to talk to a lot of informed, interesting and inspirational people at CBUS Dads. One topic we didn't know much about is pelvic health - that is until we connected with Molly Bachmann PT, DPT. We gave her the floor to explain to our community the importance of pelvic health for our children, our spouses and lastly, men.

You probably have heard of physical therapy for knee injuries while playing sports or back injuries
from sitting too long at work. Did you know there is also pelvic floor physical therapy for urinary,
bowel and sexual dysfunction as well as pelvic pain?

Let’s start with what the pelvic floor is. The pelvic floor is 3 layers of muscle that sit at the base of the
pelvis. Their most important job is to keep our organs in place and keep us upright as they work with
other postural muscles. They are unique in that they surround the urethral opening, go up to the base
of the penis and clitoris, surround the vaginal opening, and surround the rectum. These muscles are
part of what keeps us peeing and pooping regularly and what allow us to experience pleasure with
intercourse.

Physical therapists undergo advanced post-graduate education in pelvic floor anatomy and physiology
to help meet the pelvic health needs of patients. Considering the field of physical therapy as a whole,
pelvic floor physical therapy is a more recent, but a quickly emerging field.

We can help people recover from symptoms that stem from impairments in the musculoskeletal,
nervous, reproductive, urologic, and gastrointestinal systems. Pelvic health symptoms generally fall
into a few categories: bladder, bowel, sexual dysfunction, and pelvic pain. The symptoms may
develop for many different reasons, including injury, trauma, surgery, medication-induced, pregnancy,
stress, menopause, overuse - just to name a few.

Pediatric Pelvic Health
Many children suffer from bladder/bowel voiding dysfunction. In fact, 20 percent of all pediatric visits are for
incontinence problems. The good news is that non-invasive physical therapy techniques are highly
effective for these disorders. The umbrella term for difficulty with bladder/bowel control in children is
“dysfunctional voiding.” Below is a list of different diagnoses that fall under dysfunctional voiding:

• Daytime wetting
• Nighttime bedwetting (nocturnal enuresis)
• Stress incontinence
• Overactive bladder
• Urinary frequency/urgency
• Urinary retention
• Frequent urinary tract Infections
• Constipation
• Bowel incontinence and/or inability to empty bowel
• Fecal urgency/frequency

Physical therapy helps with each of these issues through a myriad of ways. After an assessment, the
therapist will determine the best approach for each child. Sometimes this may involve direct pelvic floor
exercises, others may involve addressing gaps in developmental milestones, modifying toileting behaviors
and eating habits, breathing techniques or stretches to reduce pelvic floor muscle tone.

Tips to help your kids gain continence and confidence in toileting:

1. Make sure your bathroom is set up for kiddos! Often, toilets in our homes are made for adult size bodies. This can make it hard for kids to get the appropriate posture needed for complete voiding and it can feel scary to sit on something much bigger than you!
2. Hydration matters and kids need reminders
3. Developing a strong core also develops a strong pelvic floor. Encouraging kids to play games and engage in activities that use core muscles is important throughout development!

Support for Spouses/Partners Before and After Birth
The pelvic floor and pelvic girdle muscles undergo significant changes during pregnancy and labor and
delivery. Optimal pelvic health during pregnancy can help reduce musculoskeletal pain and dysfunction,
ease labor and delivery, and help reduce postpartum complications. In 2018 the American College of
Obstetrics and Gynecology issued a statement acknowledging that postpartum care in the United States
needs to be improved, suggesting the term “4th Trimester” should be used for the immediate postpartum
period and that postpartum women need more care than what is currently being offered. All pregnant and
postpartum women can benefit from pelvic floor physical therapy given the crucial role these muscles
play during delivery and how prevalent dysfunction is after birth. Pelvic floor physical therapy reduces
the risk of pelvic organ prolapse, urinary, bowel, sexual dysfunction, and pelvic pain. Similar to other
diagnoses we treat, many of our patients tell us they wish they knew about us sooner.

During pregnancy, our bodies undergo significant changes as the pregnancy progresses. Many women
experience symptoms that pelvic floor physical therapy can address. Fortunately, some women tolerate
pregnancy very well and experience no unwanted symptoms. For these women, pelvic floor physical therapy can help with optimizing pelvic floor motor control to aid in labor and birth and improving pelvic floor and pelvic girdle neuromuscular function to reduce pain and dysfunction in the postpartum period.

All new moms should undergo an evaluation with a pelvic floor physical therapist. Ideally, this evaluation
would take place in the first year following delivery, however, it is never too late to see a pelvic floor
physical therapist. Postpartum pelvic floor physical therapy can help with:

• Urinary retention, urgency, frequency, hesitancy, pain and incontinence (leaking)
• Constipation, difficulty with bowel movement, fecal incontinence
• Painful sex, diminished or absent orgasm
• Diastasis Rectus Abdominis
• Restoring core function and strength: abdominals and pelvic floor
• Pelvic floor and pelvic girdle, low back, and hip pain
• Cesarean section and episiotomy scar tissue and pain
• Pelvic organ prolapse prevention and/or treatment
• Eliminate pain from perineal and/or levator ani trauma
• Reduce pain from pelvic neuralgias

Tips to help your partner/spouse before and after birth:

1. Call your local pelvic floor PT to make an appointment for them. Reducing the mental list of all the things that need to be done can make a huge difference and help your partner feel supported
2. Continuous labor support has continued to prove to be one of the most effective ways to reduce unnecessary medical interventions and unwanted outcomes in birth. If you are not planning on working with a doula (though you really ought to consider it!), make sure you are reading up on all things labor and birth and attending classes where you can learn physical skills to support your partner.
3. So much of the supplies we gather before birth are intended for the baby. Consider looking into things your partner may need for recovery like the ones listed here. So often I hear people say they were completely unprepared for postpartum recovery. Having equipment like these and a scheduled therapy evaluation will help to reduce the hardship in recovering from birth.

Men’s Pelvic Health
Don’t forget, you have a pelvic floor too! Studies have revealed that due to pelvic floor dysfunction, 10 percent
of men will encounter symptoms of pelvic pain. Due to misdiagnosis, many patients are prescribed
antibiotics thinking they have prostatitis. Physical therapy that is focused on pelvic floor muscle training
is the answer.

Some symptoms of pelvic floor dysfunction are:

• Typically refers to burning, itching, aching, or other types of pain in the penis, scrotum,
• testicles, perineal, and/or anal area
• Men suffering from pelvic pain often times experience pain caused by sitting, certain types of
• exercises, and certain types of clothing
• In addition to pelvic pain, men often experience urinary urgency/frequency/hesitancy as well
• as pain and slower/diminished urinary stream
• With pelvic pain, men may have discomfort in their penis, scrotum, and perinea upon
• ejaculation
• Some Men experience signs of erectile dysfunction, accompanied by reduced ejaculation
• strength
• Men may endure gastrointestinal distress, bloating, and/or constipation
• Symptoms of GI distress can be aggravated by actions like ejaculation or exercise, or
• unprovoked and spontaneous
• Men may experience these symptoms intermittently or constantly

Causes of Pelvic Pain:

• Surgical trauma (vasectomy, benign prostatic hyperplasia (BPH) interventions, prostatectomy)
• Orthopedic injuries or other traumas (spine, hip, knee, and/or ankle injuries/pathology,
• accidents)
• Biomechanical or structural dysfunction (hip dysfunction, piriformis syndrome, scoliosis, leg
• length discrepancy)
• Excessive exercise or changes to exercise routine
• Excessive sitting
• Chronic constipation and straining
• Jelqing and/or attempts at genital enhancement or foreskin regeneration
• In rare cases, bladder, prostate, or sexually transmitted infections after successful resolution of
• infection
• The majority of men with pelvic pain, with or without urinary or bowel complaints, have pelvic floor dysfunction

Tips for maintaining pelvic health:

• Figure out a stress management plan. Stress is one of the most significant causes of pelvic floor tension and dysfunction
• If you are someone who sits for work, figure out a standing schedule that will reduce adverse pressure on the pelvic floor
• Many men focus their workouts on strength. Strength is important! But it isn’t the only thing you need for longevity. Many men neglect mobility training. This is particularly important for the pelvic floor which also needs to lengthen.

To learn more about pelvic health, you can find Pelvic Health and Rehabilitation Center on
Instagram, YouTube and our website. If you think you may need an evaluation, call our
office.